More Evidence that Surgical Intervention for Unstable Distal Radius Fracture in Elderly Does not Offer a Superior Patient Perceived Functional Advantage over Time Honored Conservative Treatment in Long Term Follow-Up: A Critical Appraisal at 10 Years (Range 10-13 Years) Follow-up Study.

Raghavendra S Kulkarni, Sriram R Kulkarni
{"title":"More Evidence that Surgical Intervention for Unstable Distal Radius Fracture in Elderly Does not Offer a Superior Patient Perceived Functional Advantage over Time Honored Conservative Treatment in Long Term Follow-Up: A Critical Appraisal at 10 Years (Range 10-13 Years) Follow-up Study.","authors":"Raghavendra S Kulkarni, Sriram R Kulkarni","doi":"10.13107/jocr.2025.v15.i03.5396","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In this study, elderly distal radius fracture treatment by both conservatively and surgical intervention was examined at 1 and 2 years post-injury and then reevaluated after a median of 10 (range 10-13) years.</p><p><strong>Materials and methods: </strong>Sindhudurg residents who were treated by the author for distal radius fracture between January 01st, 2008, to December 31st, 2011, at Government District Hospital Sindhudurg are enrolled in this prospective study. The follow-up clinic was conducted in the orthopedic department from January 01st, 2022, to May 31st, 2022, with a long-term follow of 10-14 years after this original study period of 2008-2011. The patients in the study period of 2008-2011 were treated by five different treatment methods, both operative and conservative.</p><p><strong>Results: </strong>The mean patient-rated wrist evaluation score was 12 (standard deviation [SD] = 17, range 0-96). The mean EuroQol Visual Analog Scale was 81.2 (range 25-100, 95% confidence interval 76-84). The scores were lower in patients treated conservatively compared to three subgroups of surgical intervention (P = 0.03). The patient self-rated outcomes at long-term follow-up with mean ± SD values were for the surgical intervention group, pins and plaster 13.5 ± 29.6, external fixator 14.6 ± 32.1, open reduction, and internal fixation 6.3 ± 22.3. Similar values for conservatively treated patients were for below elbow cast 7.3 ± 12.5 and for above elbow cast with forearm in supination 7.2 ± 13.3, respectively. The conservatively treated patient group (mean ± SD, 11.5 ± 28.0 vs. 7.3 ± 12.9: P = 0.5) with better functional outcomes and greater satisfaction (P = 0.5) for the difference. Overall 36 (43.9%) elderly patients treated by the conservative method were very much satisfied with the eventual long-term outcome of their distal radius fracture as against 27 (35.5%) treated by surgical intervention. Similarly, 4 (4.8%) were very much dissatisfied in the conservatively treated group as against 10 (15.7%) from the surgical intervention group (P > 0.001).</p><p><strong>Discussion: </strong>Conservative treatment has always been a dilemma for surgeons. Indeed, the quality of anatomic reduction assessed on radiographs is often recognized as a predictive factor for a good functional result; however, several studies proved that this dogma was disputable. Despite wrist arthritis, the functional result is not different. A systematic review of the literature and meta-analysis comparing conservative treatment and surgical intervention found similar results.</p><p><strong>Conclusion: </strong>Elderly patients treated conservatively had overall long-term better functional outcomes and patient satisfaction with improved patient-reported daily living activities than patients treated by surgical intervention.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"227-232"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907129/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.13107/jocr.2025.v15.i03.5396","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: In this study, elderly distal radius fracture treatment by both conservatively and surgical intervention was examined at 1 and 2 years post-injury and then reevaluated after a median of 10 (range 10-13) years.

Materials and methods: Sindhudurg residents who were treated by the author for distal radius fracture between January 01st, 2008, to December 31st, 2011, at Government District Hospital Sindhudurg are enrolled in this prospective study. The follow-up clinic was conducted in the orthopedic department from January 01st, 2022, to May 31st, 2022, with a long-term follow of 10-14 years after this original study period of 2008-2011. The patients in the study period of 2008-2011 were treated by five different treatment methods, both operative and conservative.

Results: The mean patient-rated wrist evaluation score was 12 (standard deviation [SD] = 17, range 0-96). The mean EuroQol Visual Analog Scale was 81.2 (range 25-100, 95% confidence interval 76-84). The scores were lower in patients treated conservatively compared to three subgroups of surgical intervention (P = 0.03). The patient self-rated outcomes at long-term follow-up with mean ± SD values were for the surgical intervention group, pins and plaster 13.5 ± 29.6, external fixator 14.6 ± 32.1, open reduction, and internal fixation 6.3 ± 22.3. Similar values for conservatively treated patients were for below elbow cast 7.3 ± 12.5 and for above elbow cast with forearm in supination 7.2 ± 13.3, respectively. The conservatively treated patient group (mean ± SD, 11.5 ± 28.0 vs. 7.3 ± 12.9: P = 0.5) with better functional outcomes and greater satisfaction (P = 0.5) for the difference. Overall 36 (43.9%) elderly patients treated by the conservative method were very much satisfied with the eventual long-term outcome of their distal radius fracture as against 27 (35.5%) treated by surgical intervention. Similarly, 4 (4.8%) were very much dissatisfied in the conservatively treated group as against 10 (15.7%) from the surgical intervention group (P > 0.001).

Discussion: Conservative treatment has always been a dilemma for surgeons. Indeed, the quality of anatomic reduction assessed on radiographs is often recognized as a predictive factor for a good functional result; however, several studies proved that this dogma was disputable. Despite wrist arthritis, the functional result is not different. A systematic review of the literature and meta-analysis comparing conservative treatment and surgical intervention found similar results.

Conclusion: Elderly patients treated conservatively had overall long-term better functional outcomes and patient satisfaction with improved patient-reported daily living activities than patients treated by surgical intervention.

更多的证据表明,在长期随访中,手术治疗老年人不稳定桡骨远端骨折并不比保守治疗提供更优越的患者感知功能优势:一项为期10年(范围10-13年)的随访研究的关键评估。
在这项研究中,对老年人桡骨远端骨折的保守治疗和手术治疗分别在伤后1年和2年进行检查,然后在中位10年(范围10-13年)后重新评估。材料与方法:本前瞻性研究纳入2008年1月1日至2011年12月31日在Sindhudurg政府区医院接受笔者治疗的Sindhudurg居民桡骨远端骨折。随访临床于2022年1月01日至2022年5月31日在骨科进行,自2008-2011年初始研究期开始,长期随访10-14年。在2008-2011年的研究期间,患者采用了5种不同的治疗方法,包括手术和保守。结果:患者评定的腕部评估评分平均为12分(标准差[SD] = 17,范围0-96)。EuroQol视觉模拟量表平均为81.2(范围25-100,95%置信区间76-84)。保守治疗组的评分低于手术治疗组(P = 0.03)。长期随访时,手术干预组患者自评的平均±SD值为:针和石膏13.5±29.6,外固定架14.6±32.1,切开复位,内固定架6.3±22.3。保守治疗的患者肘部以下和肘部以上前臂旋后7.3±12.5和7.2±13.3的数值相似。保守治疗组(mean±SD, 11.5±28.0 vs. 7.3±12.9:P = 0.5)功能结局更好,满意度更高(P = 0.5)。总的来说,36例(43.9%)采用保守方法治疗的老年患者对其桡骨远端骨折的最终长期预后非常满意,而27例(35.5%)采用手术干预治疗。同样,保守治疗组有4人(4.8%)非常不满意,而手术干预组有10人(15.7%)非常不满意(P < 0.001)。讨论:保守治疗一直是困扰外科医生的难题。事实上,x线片上评估的解剖复位质量通常被认为是良好功能结果的预测因素;然而,一些研究证明,这一教条是有争议的。尽管手腕有关节炎,但功能结果并没有什么不同。对文献的系统回顾和比较保守治疗和手术干预的荟萃分析发现了相似的结果。结论:与手术治疗相比,保守治疗的老年患者总体上具有更好的长期功能预后和患者对改善的日常生活活动的满意度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
128
审稿时长
30 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信